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J Craniovertebr Junction Spine. 2010 Jan;1(1):44-8. doi: 10.4103/0974-8237.65481.

Combined transnasal and transoral endoscopic approaches to the craniovertebral junction.

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  • 1Department of Otololaryngology-Head and Neck Surgery, UCSF Spine Center, University of California, San Francisco, San Francisco, USA.

Abstract

OBJECTIVES:

To describe and evaluate a new technique of a combined endoscope-assisted transnasal and transoral approach to decompress the craniovertebral junction.

MATERIALS AND METHODS:

A retrospective cohort of patients requiring an anterior decompression at the craniovertebral junction over a 12-month period was studied. Eleven patients were identified and included in the study. Eight of the patients had an endoscopic approach [endonasal (2), endooral (2), and combined (4)]. Four of the 8 patients in the endoscopic group had a prior open transoral procedure at other institutions. These 8 patients were compared with a contemporary group of 3 patients who had an open, transoral-transpalatal approach. Charts, radiographic images, and pathologic diagnosis were reviewed. We evaluated the following issues: airway obstruction, dysphagia, velopharyngeal insufficiency (VPI), length of hospital stay (LOS), adequate decompression, and the need for revision surgery.

RESULTS:

Adequate anterior decompression was achieved in all the patients. The endoscopic cohort had a reduced LOS (P = 0.014), reduced need for prolonged intubation/tracheotomy (P =0.024) and a trend toward reduced VPI (P = 0.061) when compared with the open surgery group. None of the patients required a revision surgery.

CONCLUSION:

Proper choice of endoscopic transnasal, transoral, or combined approaches allows anterior decompression at the craniovertebral junction, while avoiding the need to split the palate. A combined transnasal-transoral approach appears to reduce procedure-related morbidity compared with open, transoral, and transpalatal surgeries.

KEYWORDS:

Craniovertebral junction; endonasal; endoscopic; odontoidectomy; transnasal; transoral

PMID:
20890414
[PubMed]
PMCID:
PMC2944854
Free PMC Article
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